Coca-Cola-Scholars-Program-Sample-Application.pdf

Citizenship options: Asylee, Cuban Haitian Entrant, Humanitarian

Parolee, Refugee, U.S. Citizen, U.S. National, or U.S. Permanent Resident

This document cannot be submitted to the Scholars Foundation as candidacy materials. Tips from the staff appear in red and

reflect the most common questions regarding the application.

Page 1 of 5: Biographical Information You cannot edit this section.

Your name and address have been completed from when you created your account.

*Student Name:

*Address:

*City: *State: *Zip:

*Email Address: Telephone:

Please complete ALL of the following:

*By checking this box, I certify that I am a high school senior expecting to graduate this academic year (Aug-June).

*Citizenship: Select from list

* Sex: (M/F): Select from list

*High School Code (######):

*Type of School: Select from list

*Name of school counselor for independent verification of your school records:

*Contact Email: *Contact Phone:

*Name of school principal:

*Contact Email: *Contact Phone:

The next few items are optional and are not used in the evaluation process. However, this information is extremely helpful to the

Coca-Cola Scholars Foundation in evaluating the composition of its application pool. The information you provide will be kept

confidential.

How do you describe yourself?

What was your parents’ approximate combined income before taxes last year?

Were you recommended by a Coca-Cola Scholar to apply?

If so, please provide the Scholar’s name:

Check this box if you would like to receive promotional emails and offers from The Coca-Cola Company.

Sex options: Male, Female, Other, or Prefer not to respond

Your high school code is the SAT/ACT code for your school. This is not your SAT or

ACT score. This six digit number is available from your high school counselor, school

profile, or the College Board website (this link will open in a separate window).

School Type options: Home schooled, other, parochial, private, or public.

Ethnicity Options: American Indian or Alaskan, Native Asian, Asian American or Pacific Islander, Black or African American,

Caucasian, Hispanic, or Other

Income Options: Less than $10,000, $10,000 - $14,999, $15,000 -

$24,999, $25,000 - $34,999, $35,999 - $49,999, $50,000 -

$74,999, $75,000 - $99,999, $100,000 - $149,999, $150,000 -

$199,999, or $200,000 or more

Options: No, Yes - Friend, Yes - Other, Yes - Parent or Yes - Sibling

SAMPLE APPLICATION

Page 2 of 5: School Activities

The activities in this part of the application are to include only those sponsored by your school. Community organizations,

community volunteer activities, civic clubs, and employment information are to be reported in later parts of the application, unless

they are directly sponsored by the school. Report any activity only once in the application.

Does your school limit the number of leadership roles/extracurricular activities: Yes No

If yes, what is the maximum number of leadership roles/extracurricular activities you may participate in during the school year:

Please choose the number of Leadership Roles (0-9): 9 is the maximum number that you can choose.

Please choose the number of Extracurricular Activities (0-9): 9 is the maximum number that you can choose.

Select the position/grad combination for each classification in which you participated.

School Council/ Other Student Body Governance

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Class Officer

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Academic/Honor Society (Nat’l Honor Society, Beta Club, CA Scholastic, Federation, etc.)

Grade 9:

Grade 10:

Grade 11:

Grade 12:

School Newspaper or School Literary Magazine

Grade 9:

Grade 10:

Grade 11:

Grade 12:

School Yearbook

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 Editor

 None

 Other Leadership

 Staff, Participant

Dropdown options:

 Editor

 None

 Other Leadership

 Staff, Participant

Drama, Theatre, Dance, or other Performing Arts

Enter total number (0-9) of clubs/organizations by grade in which you actively participated in Drama, Theatre, Dance, or Other

Performing Arts

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Please list up to two clubs or organizations below

Club / organization 1:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Club / organization 2:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Speech, Debate, Forensics

Enter total number (0-9) of clubs/organizations by grade in which you actively participated in Speech, Debate, or Forensics

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Please list up to two clubs or organizations below

Club / organization 1:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Club / organization 2:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Music (Band, Orchestra, Vocal)

Enter total number (0-9) of clubs/organizations by grade in which you actively participated in Music (Band, Orchestra, Vocal)

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Please list up to two clubs or organizations below

Club / organization 1:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Club / organization 2:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Visual Arts

Enter total number (0-9) of clubs/organizations by grade in which you actively participated in Visual Arts

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Please list up to two clubs or organizations below

Club / organization 1:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Club / organization 2:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Athletics

Enter total number (0-9) of high school sports by grade in which you actively participated

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Please list up to two sports below

Club / organization 1:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 Captain or Co-Captain

 JV Letter

 None

 Team Member

 Varsity

Club / organization 2:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Other School-related Clubs, Organizations, or Intramurals not previously listed.

Some examples are Key Club, Interact, DECA, 4-H, FCCLA, Math, Science and Knowledge Bowls, and Language Clubs. Community

volunteer activities, civic clubs, and employment information are to be reported in later parts of the application unless they are

directly sponsored by the school. Do not include previously listed items.

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Please list up to three clubs or organizations below

Club / organization 1:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Club / organization 2:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Club / organization 3:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Awards, Honors, Special Skills, or Talents (School or Non-school Related). List any positions/honors received each year for the school

activities indicated in the items above AND for any activities outside of school for which you have received recognition.

Choose the highest level of accomplishment (Local, State, Regional, National) for each grade. Examples of positions/honors are: Good

Citizen Award, Scholastic Athlete Award, Key Club Governor, HOBY Delegate, Girl’s/Boy’s State Delegate, All-State Choir, All-State Football,

Special skills or talents might include equestrian champion, non-school music accomplishments, community theatre, etc.

Award/Honor Grade 9 Grade 10 Grade 11 Grade 12

Dropdown options:

 Captain or Co-Captain

 JV Letter

 None

 Team Member

 Varsity

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Award Options:

Local, State,

Regional, or National

Page 3 of 5 Community Activities

The activities in this part of the application are to include only those unpaid community volunteer or internship activities.

Employment information is to be reported in the next section of the application.

Community Service / Volunteer Activities

How many volunteer hours are considered a mandatory requirement for graduation?

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Enter the total number of hours you have committed to active volunteering in grades 9-12.

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Participation in Community Service (Volunteer) Groups, Clubs, and Organizations

Enter the total number (0-9) of community groups, clubs, and organizations in which you actively performed volunteer service in

grades 9-12.

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Please list up to three clubs or organizations below

Community Service

Club / organization 1:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Community Service

Club / organization 2:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Community Service

Club / organization 3:

Grade 9:

Grade 10:

Grade 11:

Grade 12:

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Dropdown options:

 None

 Other Leadership

 President or Highest Leadership

 Staff, Representative, Participant

 VP, Secretary, Treasurer

Community Service (Volunteer) Groups, Clubs, and Organization Awards and Honors. List any awards/honors received each year

for community service (volunteer) clubs/organizations activities indicated in the items above.

For this section, you will list the award then check the box that corresponds with the grade in which the award was won.

Award/Honor Grade 9 Grade 10 Grade 11 Grade 12

Page 4 of 5: Academic Information

Your academic record is an important factor in determining advancement to the next level in the Coca-Cola Scholars Program. This

section is designed to capture as comprehensive a snapshot of your academic progress as possible.

NOTE: Refer to your most recent transcript to complete this section.

AP: Advanced Placement Courses/Dual Enrollment IB: International Baccalaureate Program

Check the box(es) below if your school offers:

Honors: If yes, how many Honors courses are offered?

IB: If yes, how many IB courses are offered?

AP: If yes, how many AP courses are offered?

Check the box below if your school offers Joint Enrollment:

Joint Enrollment:

If you participated in a joint enrollment program at a post-secondary institution, how many courses will you complete by

graduation?

Important Note: In order to be considered for the next stage of this scholarship, you must list at least two (2) completed grades in

each core area below (English, Math, Science, and Social Science). If you do not, your application will not be scored. List as many

courses as space allows that you have taken in grades 9-12. You may not have a space to list every course. Check Class Status box

to indicate classes in which you are currently enrolled.

Please obtain a copy of your transcript before working on this section. There are dropdown boxes for every class and field listed

below. Please make a selection for each dropdown available if you elect to report a grade.

Class Class Status Course Level Grade

English

English I

English II

English III

English IV

Math

Algebra

Algebra II

Geometry

Trigonometry

Class Level Options:

Advanced Placement

College Credit

Gifted Program

Honors

International Baccalaureate (IB)

Pre-AP

Regular

Class Status Options:

Completed or In Progress

Grade Options

A

B

C

D

No current grade

Open Field: If you would like to list an additional class in this subject, place it here.

IMPORTANT MESSAGE: LIST AT LEAST TWO GRADES IN THIS SECTION OR YOUR APPLICATION WILL BE REJECTED

Pre-Calculus

Calculus

Science

General Science

Biology

Physics

Chemistry

Social Science

World History

American History

Civics

Foreign Language

Lang9

Lang10

Lang11

Lang12

Arts – visual and performing

Other Courses

Class Rank: Your application cannot be accurately evaluated if you omit this section. Only answer (a) & (b) if your school ranks

students. Only answer (c) if your school does not rank, but your counselor will provide you a percentile. Only check the box for (d)

if your school does not rank and will not provide a percentile.

(a) Class Rank:

(b) (b) Class Size:

(c) If your school does not rank its students, ask your guidance counselor for an alternate, such as top 1%, top 2% etc.:

(d) If your school does not rank its students or has a policy prohibiting ranking, check this box and leave (a), (b), and (c) blank.

IMPORTANT MESSAGE: LIST AT LEAST TWO GRADES IN THIS SECTION OR YOUR APPLICATION WILL BE REJECTED

Open Field: If you would like to list an additional class in this subject, place it here.

IMPORTANT MESSAGE: LIST AT LEAST TWO GRADES IN THIS SECTION OR YOUR APPLICATION WILL BE REJECTED

Open Field: If you would like to list an additional class in this subject, place it here.

Page 5 of 5: Employment Information

Information collected in this section is only for employment for which you have been monetarily paid. If you participated in an

unpaid internship or in a voluntary capacity, please list under Volunteer Activities (page 3).

Grade 9

Number of weeks employed:

Average number of hours worked by week during the school year:

Average number of hours worked by week during the summer:

Grade 10

Number of weeks employed:

Average number of hours worked by week during the school year:

Average number of hours worked by week during the summer:

Grade 11

Number of weeks employed:

Average number of hours worked by week during the school year:

Average number of hours worked by week during the summer:

Grade 12

Anticipated weeks of employment from the beginning of school until 12/31:

Anticipated average number of hours worked per week until 12/31:

# of weeks options:

01 – 05 Weeks

06 – 10 Weeks

11 – 20 Weeks

21 – 30 Weeks

31 – 40 Weeks

41 –50 Weeks

# of hours options:

01 – 05 Hours

06 – 10 Hours

11 – 20 Hours

21 – 30 Hours

31 – 40 Hours

More than 40 hours

# of weeks options:

01 – 05 Weeks

06 – 10 Weeks

11 – 20 Weeks

21 – 30 Weeks

31 – 40 Weeks

41 –50 Weeks

# of hours options:

01 – 05 Hours

06 – 10 Hours

11 – 20 Hours

21 – 30 Hours

31 – 40 Hours

More than 40 hours

# of weeks options:

01 – 05 Weeks

06 – 10 Weeks

11 – 20 Weeks

21 – 30 Weeks

31 – 40 Weeks

41 –50 Weeks

# of hours options:

01 – 05 Hours

06 – 10 Hours

11 – 20 Hours

21 – 30 Hours

31 – 40 Hours

More than 40 hours

# of weeks options:

01 – 05 Weeks

06 – 10 Weeks

11 – 20 Weeks

21 – 30 Weeks

31 – 40 Weeks

41 –50 Weeks

# of hours options:

01 – 05 Hours

06 – 10 Hours

11 – 20 Hours

21 – 30 Hours

31 – 40 Hours

More than 40 hours